I want to express a concern in this post. I know some people begin with 1 Nexium per day, and then if they become immune to that, they then move on to 2 Nexium a day (usually one pill 30 min. before Breakfast and Dinner respectively). How often is this the case? If this is the case, then why don't we just start out with 2 Nexium a day? My acid is at it's worst when I wake up in the morning. If I take 1 pill before Breakfast as my Gastro. recommends, it's not going to last long enough to prevent my nausious acid feeling the next morning, is it?

I was diagnosed with a mildly incompetent L.E.S., Minimal GERD and minimal Gastritis. My plan is/was to use Nexium for the 1-3 months that is recommended in order to "heal". During this time I will be sticking to a strict GERD diet (I've been on it for a week, so I know I can force myself to do it). What is my plan missing? Should I take the pill once or twice a day? Should I start out with 1, move up to 2, and then ween myself back down to 1 as the 3 month point nears? The whole time I will be on the strict GERD diet and eventually try to work my way back into eating regular food. What do ya'll suggest/recommend? Thanks.

I don't know what the percentage of people who have to take Nexium twice daily is but it's relatively small. You should take 1 in the morning to see if it helps your problem. If it doesn't you may need to move to 2 but I've been on 1 daily for over a year and it works great, particularly if you do everything else you're supposed to.

I wouldn't take any more than what you need to get things under control.

What you are asking is really an individual thing. Treatment depends on the person, how they respond to various treatments and what their symptoms are.

For some, just diet and lifestyle changes work. For some, OTC meds work. For some one PPI per day will work. There are a few who need the double dose PPI to get it to work.

In my experience, I was able to keep things under "control" for years with diet and once per day Protonix. I was even able to add other foods back to my diet and do well for years. Then it stopped working and I went back to watching my diet and ended up on twice per day Prevacid Solutabs. (After testing and other treatments that didn't work.) That combination worked for me for several years. Then it stopped working. I then tried all other PPI's made. In my case nothing worked anymore. I'm still watching my diet and on twice per day Prevacid, but that is post reflux surgery.

Based on this board and posts over the years, it also seems that most people with typical GERD symptoms end up having more success with the once per day PPI's. Those with LPR symptoms often need the double dosage. Even with that, not everyone finds relief of their LPR symptoms on the PPI's.

By the way, my reflux fell in the severe category several years ago. Last summer it went into the extremely severe category. My LES was not functioning well at all. I would hope that because you aren't that bad currently that the more conservative treatments would be better. Ideally you can get things healed up and get off of the meds. Not everyone will be able to do that though. At this point, I'm on PPI's for life.

A strict GERD diet consists of cutting out things like fried foods of any kind, oily foods, acidic foods, citrus fruits, hot and spicy foods, cafeine, milk and soda. It means no fried chicken, potato chips, chocolate, orange juice, tomatoes, pizza, hot peppers, curry, soda pop, etc.... This is what I learned anyway, but basically if it makes your tummy hurt, you probably shouldn't be eating it. Doesn't leave much when you really think about it, but I manage to find lots of healthy foods I can stomach. The good thing is I don't have a weight problem.

Good luck. When I try to sneak a piece of fried chicken or cheese curls, I pay for it. Sometimes I can get away with it if I take something like mylanta before I eat and after if it's really risky, but I find that if I sneak something too often, it eventually catches up with me, and it's not worth it. I can get away with small "tastes" though, but I keep them to a limit.

I can share what I've been taught, and what works for me. I take one nexium per day. In the beginning, I tried to move up to two nexiums per day, but I found that it made me sick, and actually gave me stomachaches. My gastro was nervous about me taking two nexiums, because it was still a new medicine, and he wasn't sure what effects it could have on people. The gastros have recommended that I don't eat four hours before bed, one hour to the absolute minimum. They have also recommended that I elevate the top half of my bed. Now this can be tricky, but I found a styrofoam wedge at Sammons-Preston years ago, and I still use it. It's like a big triangle pillow, that keeps the top half of my body elevated, but I have to adjust, and find a comfortable sleeping position. If I sleep with the wedge, I have to sleep on my back, which is supposed to be the best orthopaedic position to sleep anyways. Sleeping on the wedge, may cause back problems for some people, and may cause other problems (i.e. heart) for others, so I think people should ask the doctor if it is okay, but it's up to the individual. I do take occasional anti-acids with my food if I need it, but we're not supposed to take them within two hours of taking nexium or similar drugs. Also it is now recommended that we take the nexium one whole hour before eating. Before it was half an hour, but they changed it. If I have a bad stomachache, sometimes I just drink a glass of water, this helps for some reason. Chewing gum is also supposed to help with GERD. I hope this helps.

I think it needs to be clarified what "1 per day" or "2 per day" is. I take 2 Nexium per day, but not the standard 40 mg pill. I take one 20 mg pill before breakfast and one 20 mg pill before dinner. I have been on this regemin for a year and a half now and it has helped a lot. The main reason I'm taking pills twice a day is because my symptoms are largely LPR related (sore throat, hoarseness) and taking the meds twice a day helps to reduce "break through" acid. I have had the 24 hr PH test done twice, and my results show all my acid is happening during the day. When I'm sleeping and laying flat, I have practically no acid -- maybe .01%. My GI doc told me that for some people, the LES valve naturally stays closed more tightly when the person is sleeping and these people have little acid problems at night, even though they have acid problems during the day.
Kassie

Good point on the Nexium. I went off but wonder if I should start back. So frustrating. I don't have symptoms at night either and much better lying down. Have been told this is normal for people who suffer more with LPR than GERD, which seems to be my worse problem. Sure eating early and watching my diet would help.

CharBerry is correct. In general, there is a difference at night depending on whether you have GERD or LPR.

If you look at the research, most people who have the nighttime problems that are bad have GERD. Few people with just LPR have nighttime reflux symptoms.

Personally though, I've had a lot of really bad mornings when I first get up though.

I've been on all of the PPI's once and twice per day. My twice per day dosages were at the higher level. Testing diagnosed my reflux at extremely severe. If you can be helped with the lower dosages, that is great.

Good luck. When I try to sneak a piece of fried chicken or cheese curls, I pay for it. Sometimes I can get away with it if I take something like mylanta before I eat and after if it's really risky, but I find that if I sneak something too often, it eventually catches up with me, and it's not worth it. I can get away with small "tastes" though, but I keep them to a limit.

The thing is that I am not trying to sneak anything. I used to be able to eat all these things just a few months ago, and never had problems while eating these things. I don't want to get to the point where I have to sneak, or "can get things under control". I want to eat only the right foods for a period of 3-4 months while taking the Nexium; and then be "healed". Then around October, I can start to slowly build myself back towards eating whatever I want (while no longer needing the Nexium).

Thank You to everyone who has posted their take on the matter. Mountain Reader, I'm sorry to hear about your case. I'm also curious as to how it got to be THAT bad? Do you think long usage of PPIs made your situation worse? Or was it something else (if you don't mind sharing)?

To everyone else, I'd love to hear anything and everything else you have to share on this topic. I appreciate it.

Theoretically, PPI's are intended for shorter term usage and to help heal. It may work that way for some. I have a feeling most people who are 'healed' aren't the ones who use these boards.

I started PPI's in 2002. I got by for years on PPI's eating pretty much what I wanted. At first it was just Protonix once per day that 'worked' for me as things were pretty mild. Then after several years, it stopped. That was the point where I really started watching things. Eventually I found that twice per day Prevacid "worked". After I'd been on it for a while, I was able to eat pretty much whatever if I was careful in taking the Prevacid on routine. It was just over a year and a half ago that I found it wasn't keeping things under control anymore. Ironically, I had no idea it wasn't working.

My reflux is "silent". I knew my asthma was out of control, but I had no idea that it was the reflux that was causing it because I also have environmental asthma triggers. Cold air is a major trigger and it was in the middle of winter. My asthma symptom is a cough. My reflux symptom is a cough. Figuring out what was causing the cough was tricky. When I knew it was reflux, I tried to be extremely "good".. ate well, raised the head of my bed 6 inches, etc... Still try to follow the "rules".

You are asking me to guess on why things got so bad. My guess is that all the coughing I did made things worse. The asthma/reflux thing is also a chicken and egg thing. I picked up Pertussis a couple years go. I spent 3 months violently coughing non-stop. Testing last year showed that I've developed a hiatal hernia since my EGD about 3 years ago. It also showed that my LES functioning had gotten worse. I think my bout of Pertussis may have given me the hernia. Not sure if it had anything to do with why my LES functioning was so much worse. My pursuing a surgical result was extreme, but my breathing got really bad from acid irritating my lungs and from acid aspiration. Surgery has a fairly high success rate for people with asthmatic symptoms so I chose that. Especially after I had a scary asthma attack that needed emergency care. I'm still on twice per day PPI's even post surgery though.